Physical Exam of the Shoulder

Christopher E. Baker M.D. Sports Medicine

Shoulder Reconstruction

Disclosures

• No conflicts of interest regarding the content of the talk

The Set Up

• Patient Positioning

• Patient Disrobed

Standard Physical Exam

• Inspection

• Palpation

• Range of Motion

• Strength

• Instablity

• Neurovascular

• Special Tests

Diagnosis Based Exam

• Careful history

• “Go for the money!”

Inspection

• Skin

• Muscle Atrophy• Parascapular, cuff, deltoid, biceps• Cuff tear, labral cyst, axillary nerve, Parsonage Turner,

• Deformity• AC joint, glenohumeral joint, biceps, chest wall,

scapula• AC dislocation, shoulder dislocation, proximal bicep

rupture, pec rupture, long thoracic nerve

Palpation

• C-spine – Flexion distraction injury

• AC Joint – Sprain/Fracture/DJD

• Clavicle/SC Joint – Sprain/Fracture

• Biceps Groove – Proximal tenodonitis/tearing/subluxation

• Lateral Cuff – Tendonitis/tear/calcific tendonitis

• Parascapular muscles – Muscular pain/strain

Range of Motion

• Active

• Passive

• Why is motion limited?• Pain – bursitis, tear, calcific

• Stiffness – adhesive capsulitis, DJD

• Weakness – tear, nerve injury

Strength

• Weakness

• Pain

• Injection • Therapeutic

• Diagnostic

Instability

• Range of motion

• Load and shift

• Sulcus

• Apprehension

• Relocation

• Beighton Score

Neurovascular

• Radial pulses bilateral

• Thoracic Outlet• Roos Test (90-180 sec)

• Adson’s Test

• Allen’s Test

Special Tests

• 1000+1

• Labral

• Subscap

• Instability

Take Away

• Thorough history

• Know your anatomy

• Set up

• Expose patient for inspection

• Palpation

• Strength/ROM why?

• Special tests

Questions?